Gerontology exam 3
A 77-year-old client being treated for angle-closure glaucoma asks the nurse what caused the glaucoma. The nurse's response should be based on what fact regarding glaucoma? a. The angle of the iris causes obstruction of fluid in the eye. b. Spasms of the orbicular muscle. c. Changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. Bits of broken coalesced vitreous from the peripheral or central part of the retina.
A
A frail, elderly widow is admitted to the hospital after sustaining a fall. The client lives alone and has no living relatives. After cognitive testing reveals mild cognitive impairment, the interdisciplinary team on the Acute Care for the Elderly Unit recommends long-term care placement and that a durable power of attorney for health care (DPOA-HC) be established. When the client seems confused over what a DPOA-HC's responsibilities are, the nurse responds best with which statement? a. "A DPOA
A
An older adult client has been voluntarily admitted for treatment of alcohol dependency. In implementing care, the nurse plans which intervention based upon knowledge about alcohol and aging? a. Assessing the client for both depression and anxiety b. Discussing the poor prognosis of this disorder with the client c. Explaining the need for proper nutrition to minimize the effects of alcoholism d. Identifying the effects of chronic alcoholism on the human body
A
An older adult client shares with the nurse that, "I don't know what it is but it seems that I need more light for reading or even watching television as I get older." The nurse explains that this change is due to what aging effect? a. Yellowing of the lens. b. Impact arcus senilis has on visual acuity c. Flattening and thinning of the cornea. d. Retinal changes that begin to occur with aging.
A
An older client admitted to the hospital after having sustained a fall at home is diagnosed with a right hip fracture and experienced a surgical reduction of the fracture in the AM. At 2:30 AM, the client awakens from sleep insisting that, "my daughter is in the other room and I want to see her". Attempts to reorient the client to the surroundings are unsuccessful. In reviewing the client's record, what data would be considered a primary risk factor for the delirium? a. History of dementia b. D
A
An older client reports to a nurse, "My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well." Based on the client's description, the nurse suspects which sens
A
An older patient tells a nurse, "The doctor says I have something wrong with my eyes, something called presbyopia. Can you explain why I have this? I was always fortunate to have good eyesight." The nurse formulates a response based on what knowledge? a. The lens of the eye loses elasticity causing a loss of focus for near objects. b. The cornea of the eye becomes thicker and less curved causing an increase in astigmatism. c. The lens of the eye increases in opacity causing a decrease in light
A
An older resident in a long-term care facility reports to the nurse that they has been noticing changes in their vision, including the appearance of halos around objects and a yellow tint to most objects. The nurse knows that these complaints are most often associated with what vision disorder? a. Cataracts. b. Glaucoma. c. Diabetic retinopathy. d. Age-related macular degeneration.
A
An older woman tearfully tells a nurse, "I must buy my neighbor all their groceries or they won't drive me to the store or the doctor." This is an example of which type of elder mistreatment? a. Financial exploitation b. Psychological abuse c. Caregiver neglect d. Abandonment
A
The nurse is caring for an older client who experienced a hip replacement surgery 10 hours ago. Which intervention will help minimize this client's risk of developing delirium? a. Requesting that staff offer fluids each time they interact with the client b. Medicating the client to best facilitate restorative sleep c. Encouraging the client to remain still and thus minimize pain d. Suggesting that visitors are limited to family members only
A
What is the greatest risk for injury for a client with progressed Parkinson's disease? a. Falls. b. Suicide. c. Bleeding ulcers. d. Respiratory arrest.
A
When assessing an older client for indications of depression, the nurse bases the intervention on what knowledge? a. The older client's symptoms may be somatic in nature b. Depression is a common mental disorder among the older population c. The older client is generally willing to discuss his or her mental health symptoms d. Depression is not as commonly seen in this population as are anxiety disorders
A
A nurse working in an emergency department is caring for an 89-year-old adult brought to the hospital by an adult child for a fracture of the right arm. The patient is wheelchair dependent and lives with their adult child who is the primary caregiver. The adult child states that the patient got up out of the wheelchair unassisted to go to the bathroom and fell. The patient cannot recall the circumstances of the fall. The patient is weeping and cradling their right arm. The patient's history reve
A,B
A diagnosis of Parkinson's disease is made based on the presence of which of the following symptoms? (Select all that apply.) a. Rigidity b. Resting tremor c. Bradykinesia d. Orthostatic hypotension e. Progressive decline in cognitive function
A,B,C
A nurse is developing an educational session for a group of older adults at a senior center. Which fact would the nurse include in the education? (Select all that apply.) a. Attention span, language, and communication skills typically remain stable with increasing age. b. Older brains slow down and take longer to process constantly increasing amounts of information. c. In order to preserve brain function, it is important to engage in challenging cognitive activities. d. Older adults are not abl
A,B,C
A nurse is performing preoperative teaching for an older adult who is scheduled to have a cataract extraction and lens implant. The nurse includes which of the following in the teaching plan? (Select all that apply.) a. Avoid lifting heavy objects after the surgery. b. Avoid bending from the waist after the surgery. c. Take stool softeners as needed. d. Maintain strict control of your blood sugar and blood pressure. e. Maintain a dry sterile dressing over the eye for 10 days.
A,B,C
A nurse is preparing education on elder abuse for a group of older adults and caregivers at a senior center. The nurse preparing to discuss seniors who are more likely to be abused or neglected includes which of the following? (Select all that apply.) a. Individuals with cognitive impairment b. Individuals who abused the caregiver earlier in life c. Individuals who live in an institutional setting d. Individuals who are married and living with a spouse e. Men living alone or in a household with
A,B,C
An older patient is diagnosed with diabetic retinopathy. The patient asks a nurse: "Is there anything that I can do to prevent progression of this disease and blindness?" The nurse includes which of the following into the response? (Select all that apply.) a. Strict control of blood glucose levels is important in slowing disease progression. b. Laser photocoagulation treatments can stop progression of the disease. c. Control of blood pressure and cholesterol levels are important steps slowi
A,B,C
A nurse is assessing an older patient experiencing new-onset confusion. The nurse understands that in order to have a diagnosis of delirium, the patient must exhibit which of the following? (Select all that apply.) a. Acute onset of symptoms or fluctuating course b. Inattention c. Disorganized thinking d. Altered level of consciousness e. Flat affect
A,B,C,D
A nurse is providing glaucoma education for a group of older adults in a senior center. The nurse knows that the following groups are most likely to develop glaucoma and so be the focus of the education? (Select all that apply.) a. African Americans b. Mexican Americans c. Individuals with a family history of glaucoma d. Individuals with diabetes e. Asian Americans
A,B,C,D
A nurse in an assisted living community notes that one of the residents who is diagnosed with a hearing impairment has new bilateral hearing aids. The resident is observed frequently not wearing the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all that apply.) a. Difficulty placing hearing aid properly in the ear b. Stigma associated with wearing a hearing aid c. Difficulty changing the batteries in the hearing aid d
A,B,C,E
A nurse is conducting an assessment of an older patient's eyes. The nurse expects to see which of the following normal age-related changes of the external eye? (Select all that apply.) a. The eyelids are less elastic and droopy. b. The eyes are very dry. c. The eyelids may not close completely. d. There is a loss of eyelashes. e. The lower lid may be turned outward.
A,B,C,E
An older patient is concerned that a neighbor was recently diagnosed with Alzheimer's disease and asks a nurse what can be done to decrease the risk of Alzheimer's disease. The nurse includes which of the following in the response to the patient? (Select all that apply.) a. Maintain blood pressure within normal limits. b. Smoking cessation. c. Maintain control of blood sugar (hemoglobin A1C £7). d. Eliminate fats from the diet. e. Maintain healthy body weight.
A,B,C,E
Which intervention to manage a wandering client in a long-term care facility should be implemented? (Select all that apply.) a. Walk with the person, allowing them control within the bounds of safety. b. Redirect the person back toward the facility. c. Call the person by his or her formal name. d. Using physical restraints to prevent wandering to maintain safety. e. Make direct eye contact with the person.`
A,B,C,E
A nurse hears a colleague state the following: "Can you believe that Mr. Jones' daughter just bought him a tablet computer? He is 90 years old. It is ridiculous to think that he can learn to use it." The nurse formulates a response based on what research? (Select all that apply.) a. Older adults comprise the fastest growing population using computers and the Internet. b. Internet use is less prevalent in individuals over age 75 than those ages 65-74. c. Older American men are the fastestgrowing
A,B,E
A nurse is assisting an older adult to cope with depression after the loss of a spouse. Which of the following actions should the nurse take? (Select all that apply.) a. Encourage the person to develop a daily activity schedule that includes pleasant activities. b. Validate depressed feelings as aiding recovery. c. Discourage angry outbursts. d. Suggest that the person not make any decisions until the depression has passed. e. Involve the family in teaching about depression.
A,B,E
An older adult is referred to a geriatric nurse practitioner because of changes in memory and reports by family members that "there is something different about her." The nurse practitioner evaluates the older adult for which potentially reversible causes for the changes? (Select all that apply.) a. Depression. b. Delirium. c. Osteoporosis. d. Rheumatoid arthritis. e. Medication side effects.
A,B,E
An older adult is diagnosed with Alzheimer's disease. The nurse knows that this diagnosis is made on the presence of which of the following? (Select all that apply.) a. A decline from a previous level of functioning b. Fluctuation of symptoms over the course of a 24-hour period c. An insidious onset d. A gradual decline in cognitive abilities e. The cognitive changes worsen in the evening hours
A,C
What differences in the presentation are there between patients with Alzheimer's disease (AD) and Dementia with Lewy bodies (DLB)? (Select all that apply.) a. Individuals with LB develop motor symptoms, and individuals with AD do not. b. Individuals with AD display impairments in judgment whereas individuals with LB do not. c. The use of traditional atypical medication is contraindicated for individuals with LB. d. LB usually occurs in individuals under age 60, and AD occurs in individuals on
A,C
A nurse understands that the pathophysiology of Parkinson's disease includes which of the following? (Select all that apply.) a. A deficiency of the neurotransmitter dopamine b. An inability of the neurons to absorb dopamine c. A reduction of dopamine receptors d. An accumulation of Lewy Bodies, especially in the basal ganglia e. The presence of neurofibrillary tangles and amyloid plaques in the brain
A,C,D
An older adult client reports hearing whistling in both ears when no external sounds are present and is diagnosed with tinnitus. Which of the following are causes of tinnitus that the nurse discusses with the client? (Select all that apply.) a. Exposure to loud noises b. Use of a hearing aid c. Cerumen buildup d. Side effects of medications e. Age-related changes in the middle and inner ear
A,C,D
A nurse is conducting an assessment of an older adult in a geriatric clinic. The patient states drinking two to three alcoholic beverages daily. The patient has multiple chronic comorbid conditions and is on five different medications. Which of the following medications is the nurse concerned will interact with the alcohol? (Select all that apply.) a. Naproxen for pain b. Daily multivitamin c. Fluoxetine for depression d. Celecoxib for arthritis e. Metoprolol succinate for hypertension
A,C,E
An older resident of an assisted living facility says the following to a nurse: "I am very frightened about getting dementia. I have read a lot about brain exercises, but I am not sure what I should be doing." The nurse formulates a response based on knowledge of which of the following? (Select all that apply.) a. Individuals should engage in some type of brain exercising activity a couple of times a week for at least 25 minutes. b. Brain exercising activities are only effective if an individu
A,C,E
A nurse is planning a fall prevention education refresher session for the residents of a long-term care facility. The individuals are all cognitively intact and range in age from 80 to 100. The previous education on fall prevention was presented 2 months ago. What special considerations should the nurse take in relation to teaching this group of older adults? (Select all that apply.) a. Make sure that all pamphlets are in large readable font (14-16 points) and include upper- and lower-case lett
A,D,E
When discussing electroconvulsive therapy (ECT) with an older, chronically depressed adult and his family, which statement will the nurse use to support this intervention? (Select all that apply.) a. "This treatment has been shown to be effective in individuals who have not responded well to antidepressant medications." b. "ECT is contraindicated in frail adults with multiple comorbidities." c. "ECT is a safe intervention for those with psychotic ideation." d. "ECT is the most effective treatme
A,D,E
When a cognitively impaired, wealthy, white client is noted to have burns on her upper back, her son states that the patient burned herself when attempting to shower. Which statement by a member of the team reflects a need for further education on elder abuse? (Select all that apply.) a. "She is wealthy; abuse does not happen in people of financial means." b. "Even if we are not sure, we are legally bound to report our suspicions." c. "We need to consider that most abusers are either adult chil
A,E
An older adult with suspected Parkinson's disease has a "challenge test" performed in order to confirm the diagnosis. The nurse understands that a "challenge test" will demonstrate which of the following? a. Immediate reversal of all symptoms of Parkinson's disease after administration of levodopa b. Dramatic improvement of symptoms of Parkinson's disease after administration of levodopa c. Dramatic improvement in gait only after administration of levodopa d. Dramatic improvement
B
An older client diagnosed with dementia resides with his daughter. When the homecare nurse visits, the daughter tearfully tells the nurse that her father scratched her hand and cursed at her when she was attempting to feed him. She states, "I don't know why he hates me and wants to hurt me. I try so hard to take good care of him. I love him." How will the nurse respond to the client's daughter? a. "Let's think about what you may have done to anger your father?" b. "Let's try to figure out what
B
A nurse administers the Short Michigan Alcohol Screening Test Geriatric Version (S-MAST-G) to an older adult. When the older adult receives a score of "2," the nurse knows that this score is indicative of which of the following? a. No problem with alcohol b. A problem with alcohol c. A mild problem with alcohol d. A severe problem with alcohol
B
A nurse is caring for a patient with a diagnosis of delirium. Which of the following is an expected assessment finding for this patient? a. Normal attention span b. Fluctuation in symptoms c. Normal sleep cycle d. Increased appetite
B
After having recently experienced a number of stressful life events, an older adult client comes to the ambulatory clinic and tells the nurse that, "On top of all I've had to endure, now I've got this flu!" In rendering care for this client, the nurse recognizes which of the following? a. The client is exhibiting attention-seeking behaviors to substitute for poor coping skills. b. Crisis and stressful situations may produce emotions that erode the health of the older people. c. The cliet is exh
B
An older adult says to the nurse, "I don't know why I can't handle booze like I used to when I was younger." The nurse's response is based on what knowledge? a. Older adults develop higher blood alcohol levels due to age-related changes in the neurological system. b. Older adults develop higher blood alcohol levels due to age-related changes that alter absorption and distribution of alcohol. c. Older adults develop higher blood alcohol levels due to slowed reaction times. d. Older adults develo
B
An older client in an adult day care program tells the nurse, "I'm very stressed because another neighbor passed away." What is the most therapeutic response by the nurse? a. "You are experiencing grief, not stress." b. "Tell me what you did when your other neighbor passed away." c. "Are you worrying about your own death?" d. "Let's get involved in some activities and not think about sad things."
B
An older patient reports the following symptoms to a nurse during a routine visit to the geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the middle of his visual field. The client also states, "Strangely enough my peripheral vision continues to be pretty good." The nurse suspects that the patient has which of the following vision disorders? a. Glaucoma b. Age-related macular degeneration c. Diabetic retinopathy d. Cataracts
B
An older resident in a senior community tells a nurse: "I am really worried. I joined an exercise class, and I just learned everyone's name yesterday, and I cannot remember them all today. Am I developing Alzheimer's disease?" What is the best response by the nurse? a. "You should be concerned. It is very unusual to forget something that you just learned." b. "Let's monitor your recall abilities to see if the problem persists." c. "Don't worry, a decline in both short- and long-term memory is a
B
How is health literacy best defined? a. It the capacity to read basic health information in order to make appropriate health decisions. b. It the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions. c. It the capacity to read and write in order to access health care. d. It the capacity to read and execute health care documents.
B
How should the nurse reply when an older adult asks, "How much alcohol is good for you?" a. "Alcohol isn't good for you so avoid it as a general rule." b. "Experts in the field recommend only one regular sized drink a day." c. "It's been said that red wine has health benefits, but that doesn't mean drink a whole bottle." d. "If you are only drinking on special occasions, limit yourself to two drinks."
B
In order to focus on the older population with the greatest risk for suicide, the nurse would conduct a depression screening that targets which population? a. African American men b. White men c. White women d. African American women
B
The nurse is providing care to a client diagnosed with dementia. What option is an example of the appropriate use of implied consent by the nurse? a.Preparing to draw blood from a client's arm after asking, "Can I see your arm?" b. Changing the client's dressing when the client asks, "Will you change this bandage now?" c. Using the client's monthly allowance to buy a watch when he continuously asks for the time d. Arranging for a benign mole to be removed after the client states,
B
The nurse preparing educational information on the most common mental health disorder among the older adult population should include information on which of the following? a. Methods for reducing anxiety. b. A written depression screening tool. c. Local schizophrenia support groups. d. Signs and symptoms of alcoholism.
B
Which intervention best addresses the principle that is the basis for communicating with a client experiencing postsurgical delirium? a. Reminding the client that delirium is generally acute and reversible b. Assuming that the client's statements are an attempt to express needs c. Allowing the client sufficient time to formulate an answer to questions d. Using nonverbal communication techniques to communicate with the client
B
You have four rooms to choose from for your older client to be admitted this afternoon. Which room would you choose to best suit safety needs? a. A brightly lit, blue room with cozy throw rugs b. An orange-carpeted room with soft lighting and yellow walls c. A brightly lit, blue room with an EZ-Glide wax floor d. A fluorescent-lighted room with green walls and a glossy, tiled floor
B
A nurse in a long-term care facility is approached by an older resident who is crying and states: "You need to help me. The mean little men are in my room again. They are watching me from the corner, and they are laughing at me. Make them go away." The nurse accompanies the resident to the room and there is no one in the corner of the room. What is the best response by the nurse? (Select all that apply.) a. "Yup, I see them. Let me call security to haul the men away." b. "Can you tell me what y
B,C,D
A nurse in a long-term care facility is concerned that a 94-year-old resident with dementia is losing weight. Upon assessment, the nurse notes that the resident, who is able to self-feed independently, consumes less than 50% of each of the meal trays. Which of the following strategies can the nurse utilize to improve this resident's intake? (Select all that apply.) a. Assign a nursing assistant to feed the resident. b. Assign a nursing assistant to sit with the resident as the resident eats. c.
B,C,D,E
Which information will the nurse manager include when discussing the major differentiation between delirium and dementia with novice nurses? (Select all that apply.) a. The delirious client learns to make up answers to hide his or her confusion. b. Delirium requires increased monitoring at night. c. The client diagnosed with dementia generally looks frightened. d. Dementia results in a steady decline in cognitive abilities. e. Delirium is characterized by fluctuations in alertness.
B,C,E
A nurse suspects elder mistreatment in which of the following patients seen in the emergency department? (Select all that apply.) a. An 85-year-old with cardiac disease who is taking blood thinners and has multiple bruises on their arms and hands. b. An 86-year-old nursing home resident admitted to the hospital with perineal bleeding and three large bruises on the inner thigh. c. A 77-year-old who fell at home and broke the left arm after tripping over a pet cat. d. A 73-year-old with a history
B,E
A nurse is caring for an older adult diagnosed with Parkinson's disease. The patient is receiving the medication levodopa-carbidopa. The nurse understands that in order to maximize effectiveness, the administration schedule for this medication should adhere to which of the following? a. Administer with meals only b. Administer first thing in the morning only c. Administer on an empty stomach, 30-60 minutes before or 45-60 minutes after a meal d. Administer with a full 8 oz of water and have t
C
A nurse suspects that the next-door neighbor, an older adult, is a victim of elder abuse by an adult child. What is the appropriate action for the nurse to do in this situation? a. Because the neighbor is not a patient, the nurse should not get involved. b. Visit the neighbor frequently to confirm the suspicions. c. Complete a confidential report with the adult protective services in the area. d. Ask the neighbor if they are being abused.
C
An older nursing home resident reports that, "My hearing loss is getting worse." What is the first action of the nurse? a. Refer the resident for an evaluation for a hearing aid. b. Raise her voice when speaking to the resident. c. Examine the resident's ears for cerumen impaction. d. Teach the resident to read lips.
C
The nurse demonstrates an understanding of dementia's risk factors when focusing on which assessment? a. Elimination patterns. b. Capillary refill status. c. Genetic makeup. d. Reflex times.
C
Which of the following statements made by a family caregiver would a nurse consider most indicative of elder abuse? a. "I get so frustrated because my father used to be so competent and now cannot even feed himself." b. "Mom cannot pay her own bills anymore. We went to the bank and arranged for me to have access to her checking account and help her pay the bills." c. "My dad wanders at night and I can't be bothered with him. I mix sleeping pills in his dinner so that he will fall asleep." d.
C
When an older adult reports experiencing several different stressors over the last 6 months, the nurse demonstrates an understanding of the physiological effects of stress on the body by implementing what intervention? (Select all that apply.) a. Assessing the client using the Geriatric Depression Scale (GDS). b. Testing the client's urine for red blood cells c. Screening the client for abnormally high serum glucose levels d. Inquiring as to whether the client has experienced weight changes e A
C,D
A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which information will be included in the nurse's teaching plan? a. "Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure." b. "With the right hearing aid, you can expect your hearing to be back to normal." c. "Hearing aids are covered by Medicare Part B." d. "Even though hearing aids will h
D
A nurse caring for an older patient diagnosed with bipolar disorder knows that the patient needs additional education when the patient makes what statement? a. "Bipolar disorder often results in 'a leveling out' of symptoms as one ages." b. "Relapses in bipolar disorder tend to be precipitated by medical problems." c. "The length of the phases of depression and mania varies." d. "Bipolar disorder is the most commonly diagnosed psychiatric disorder in older adults."
D
An older patient asks a nurse, "My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?" The nurse formulates a response based on what knowledge? a. A cochlear implant is a permanent, surgically implanted hearing aid. b. A cochlear implant speeds up the conduction of sound to the auditory nerve. c. A cochlear implant functions as an artificial auditory nerve. d. A cochlear implant d
D
Which option is an example of elder exploitation? a. A homebound client is left alone for days at a time by the caregiver. b. An older client is smacked if he doesn't eat all of his food. c. A client diagnosed with Alzheimer's disease is bathed only twice a month. d. A homebound client can only get groceries by agreeing to pay for her neighbor's groceries, too.
D
An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include which auditory disorders? (Select all that apply.) a. Tumors of the middle ear. b. Cerumen impaction. c. Infections of the external and middle ear. d. Age-related hearing impairment like presbycusis e. Prolonged exposure to excessive and loud noise.
D,E
A nurse is caring for a 92-year-old female patient who was admitted to the hospital 1 day after outpatient cataract surgery. The patient who lives in an assisted living facility became very confused and agitated and was found wandering in the lobby of the building in her nightgown. The patient refused to return to their room and stated that there were "bad men" in the room. The patient has a history of dementia, diabetes, heart failure, and is on seven different medications. The patients lost th
a,c,e